Kona Community Hospital

All Charges

Charge

Type

Setting

Price

NP PROMETHAZINE 25 MG #2 SUPP (WHR)

Facility

$164.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$83.95
Max. Negotiated Rate	$159.66
Rate for Payer: Cash Price	$106.99
Rate for Payer: Hawaii Western Management Group Commercial	$156.37
Rate for Payer: Health Management Network Commercial	$139.91
Rate for Payer: Kaiser Permanente Commercial	$103.70
Rate for Payer: Kaiser Permanente Medicaid	$83.95
Rate for Payer: MDX Hawaii PPO	$159.66
Rate for Payer: UnitedHealthcare Medicaid	$98.76
Rate for Payer: University Health Alliance Commercial	$119.98

NP PROMETHAZINE 25 MG #2 SUPP (WHR)

Facility

$164.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$139.91
Max. Negotiated Rate	$159.66
Rate for Payer: Cash Price	$106.99
Rate for Payer: Health Management Network Commercial	$139.91
Rate for Payer: MDX Hawaii PPO	$159.66

NP PROMETHAZINE 25 MG #5 TAB (WHR)

Facility

$13.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$13.55
Rate for Payer: Cash Price	$9.08
Rate for Payer: Health Management Network Commercial	$11.87
Rate for Payer: MDX Hawaii PPO	$13.55

NP PROMETHAZINE 25 MG #5 TAB (WHR)

Facility

$13.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$13.55
Rate for Payer: Cash Price	$9.08
Rate for Payer: Hawaii Western Management Group Commercial	$13.27
Rate for Payer: Health Management Network Commercial	$11.87
Rate for Payer: Kaiser Permanente Commercial	$8.80
Rate for Payer: Kaiser Permanente Medicaid	$7.12
Rate for Payer: MDX Hawaii PPO	$13.55
Rate for Payer: UnitedHealthcare Medicaid	$8.38
Rate for Payer: University Health Alliance Commercial	$10.18

NP RALTEGRAVIR 400 MG #6 TAB (WHR)

Facility

$672.48

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$342.96
Max. Negotiated Rate	$652.31
Rate for Payer: Cash Price	$437.11
Rate for Payer: Hawaii Western Management Group Commercial	$638.86
Rate for Payer: Health Management Network Commercial	$571.61
Rate for Payer: Kaiser Permanente Commercial	$423.66
Rate for Payer: Kaiser Permanente Medicaid	$342.96
Rate for Payer: MDX Hawaii PPO	$652.31
Rate for Payer: UnitedHealthcare Medicaid	$403.49
Rate for Payer: University Health Alliance Commercial	$490.17

NP RALTEGRAVIR 400 MG #6 TAB (WHR)

Facility

$672.48

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$571.61
Max. Negotiated Rate	$652.31
Rate for Payer: Cash Price	$437.11
Rate for Payer: Health Management Network Commercial	$571.61
Rate for Payer: MDX Hawaii PPO	$652.31

NP SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG #4 TAB (WHR)

Facility

$6.98

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$6.77
Rate for Payer: Cash Price	$4.54
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$5.93
Rate for Payer: Kaiser Permanente Commercial	$4.40
Rate for Payer: Kaiser Permanente Medicaid	$3.56
Rate for Payer: MDX Hawaii PPO	$6.77
Rate for Payer: UnitedHealthcare Medicaid	$4.19
Rate for Payer: University Health Alliance Commercial	$5.09

NP SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG #4 TAB (WHR)

Facility

$6.98

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$6.77
Rate for Payer: Cash Price	$4.54
Rate for Payer: Health Management Network Commercial	$5.93
Rate for Payer: MDX Hawaii PPO	$6.77

NP TRAMADOL 50 MG #5 TAB (WHR)

Facility

$4.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.69
Rate for Payer: Cash Price	$3.14
Rate for Payer: Health Management Network Commercial	$4.11
Rate for Payer: MDX Hawaii PPO	$4.69

NP TRAMADOL 50 MG #5 TAB (WHR)

Facility

$4.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$4.69
Rate for Payer: Cash Price	$3.14
Rate for Payer: Hawaii Western Management Group Commercial	$4.59
Rate for Payer: Health Management Network Commercial	$4.11
Rate for Payer: Kaiser Permanente Commercial	$3.04
Rate for Payer: Kaiser Permanente Medicaid	$2.46
Rate for Payer: MDX Hawaii PPO	$4.69
Rate for Payer: UnitedHealthcare Medicaid	$2.90
Rate for Payer: University Health Alliance Commercial	$3.52

NP ZOFRAN ODT 4 MG #4 TAB (WHR)

Facility

$407.78

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$207.97
Max. Negotiated Rate	$395.55
Rate for Payer: Cash Price	$265.06
Rate for Payer: Hawaii Western Management Group Commercial	$387.39
Rate for Payer: Health Management Network Commercial	$346.61
Rate for Payer: Kaiser Permanente Commercial	$256.90
Rate for Payer: Kaiser Permanente Medicaid	$207.97
Rate for Payer: MDX Hawaii PPO	$395.55
Rate for Payer: UnitedHealthcare Medicaid	$244.67
Rate for Payer: University Health Alliance Commercial	$297.23

NP ZOFRAN ODT 4 MG #4 TAB (WHR)

Facility

$407.78

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$346.61
Max. Negotiated Rate	$395.55
Rate for Payer: Cash Price	$265.06
Rate for Payer: Health Management Network Commercial	$346.61
Rate for Payer: MDX Hawaii PPO	$395.55

NS 1000 ML WITH KCL 20 MEQ/L IV PREMIX

Facility

$63.54

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$54.01
Max. Negotiated Rate	$61.63
Rate for Payer: Cash Price	$41.30
Rate for Payer: Cash Price	$17.94
Rate for Payer: Cash Price	$28.25
Rate for Payer: Health Management Network Commercial	$54.01
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Health Management Network Commercial	$23.46
Rate for Payer: MDX Hawaii PPO	$26.77
Rate for Payer: MDX Hawaii PPO	$42.16
Rate for Payer: MDX Hawaii PPO	$61.63

NS 1000 ML WITH KCL 20 MEQ/L IV PREMIX

Facility

$27.60

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$26.77
Rate for Payer: Cash Price	$17.94
Rate for Payer: Cash Price	$28.25
Rate for Payer: Cash Price	$41.30
Rate for Payer: Cash Price	$17.94
Rate for Payer: Cash Price	$41.30
Rate for Payer: Cash Price	$28.25
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$41.29
Rate for Payer: Hawaii Western Management Group Commercial	$26.22
Rate for Payer: Hawaii Western Management Group Commercial	$60.36
Rate for Payer: Health Management Network Commercial	$54.01
Rate for Payer: Health Management Network Commercial	$23.46
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Kaiser Permanente Commercial	$40.03
Rate for Payer: Kaiser Permanente Commercial	$27.38
Rate for Payer: Kaiser Permanente Commercial	$17.39
Rate for Payer: Kaiser Permanente Medicaid	$14.08
Rate for Payer: Kaiser Permanente Medicaid	$32.41
Rate for Payer: Kaiser Permanente Medicaid	$22.16
Rate for Payer: MDX Hawaii PPO	$61.63
Rate for Payer: MDX Hawaii PPO	$42.16
Rate for Payer: MDX Hawaii PPO	$26.77
Rate for Payer: UnitedHealthcare Medicaid	$16.56
Rate for Payer: UnitedHealthcare Medicaid	$26.08
Rate for Payer: UnitedHealthcare Medicaid	$38.12
Rate for Payer: University Health Alliance Commercial	$31.68
Rate for Payer: University Health Alliance Commercial	$20.12
Rate for Payer: University Health Alliance Commercial	$46.31

NS 1000 ML WITH KCL 40 MEQ/L IV PREMIX

Facility

$38.62

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$32.83
Max. Negotiated Rate	$37.46
Rate for Payer: Cash Price	$25.10
Rate for Payer: Cash Price	$34.53
Rate for Payer: Health Management Network Commercial	$32.83
Rate for Payer: Health Management Network Commercial	$45.16
Rate for Payer: MDX Hawaii PPO	$37.46
Rate for Payer: MDX Hawaii PPO	$51.54

NS 1000 ML WITH KCL 40 MEQ/L IV PREMIX

Facility

$53.13

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$51.54
Rate for Payer: Cash Price	$34.53
Rate for Payer: Cash Price	$25.10
Rate for Payer: Cash Price	$25.10
Rate for Payer: Cash Price	$34.53
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$36.69
Rate for Payer: Hawaii Western Management Group Commercial	$50.47
Rate for Payer: Health Management Network Commercial	$45.16
Rate for Payer: Health Management Network Commercial	$32.83
Rate for Payer: Kaiser Permanente Commercial	$33.47
Rate for Payer: Kaiser Permanente Commercial	$24.33
Rate for Payer: Kaiser Permanente Medicaid	$19.70
Rate for Payer: Kaiser Permanente Medicaid	$27.10
Rate for Payer: MDX Hawaii PPO	$51.54
Rate for Payer: MDX Hawaii PPO	$37.46
Rate for Payer: UnitedHealthcare Medicaid	$23.17
Rate for Payer: UnitedHealthcare Medicaid	$31.88
Rate for Payer: University Health Alliance Commercial	$28.15
Rate for Payer: University Health Alliance Commercial	$38.73

NURSERY CONTINUOUS CARE

Facility

$2,200.00

Hospital Charge Code	H0000020
Hospital Revenue Code	172
Min. Negotiated Rate	$1,870.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Cash Price	$1,430.00
Rate for Payer: Cash Price	$1,430.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,250.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: University Health Alliance Commercial	$1,875.00

NURSERY INTERMEDIATE

Facility

$3,300.00

Hospital Charge Code	H0000019
Hospital Revenue Code	173
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$2,145.00
Rate for Payer: Cash Price	$2,145.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,250.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,875.00

NURSERY NNB

Facility

$1,775.00

Hospital Charge Code	H0000017
Hospital Revenue Code	171
Min. Negotiated Rate	$1,508.75
Max. Negotiated Rate	$2,250.00
Rate for Payer: Cash Price	$1,153.75
Rate for Payer: Cash Price	$1,153.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,250.00
Rate for Payer: Health Management Network Commercial	$1,508.75
Rate for Payer: MDX Hawaii PPO	$1,721.75
Rate for Payer: University Health Alliance Commercial	$1,875.00

Nut 14mm 04.045.781S [3644727]

Facility

$2,400.93

Hospital Charge Code	3644727
Hospital Revenue Code	272
Min. Negotiated Rate	$1,224.47
Max. Negotiated Rate	$2,328.90
Rate for Payer: Cash Price	$1,560.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,280.88
Rate for Payer: Health Management Network Commercial	$2,040.79
Rate for Payer: Kaiser Permanente Commercial	$1,512.59
Rate for Payer: Kaiser Permanente Medicaid	$1,224.47
Rate for Payer: MDX Hawaii PPO	$2,328.90
Rate for Payer: University Health Alliance Commercial	$1,750.04

Nut 14mm 04.045.781S [3644727]

Facility

$2,400.93

Hospital Charge Code	3644727
Hospital Revenue Code	272
Min. Negotiated Rate	$2,040.79
Max. Negotiated Rate	$2,328.90
Rate for Payer: Cash Price	$1,560.60
Rate for Payer: Health Management Network Commercial	$2,040.79
Rate for Payer: MDX Hawaii PPO	$2,328.90

NYSTATIN 100000 UNIT/G TOP CR

Facility

$127.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$123.24
Rate for Payer: Cash Price	$82.58
Rate for Payer: Cash Price	$82.34
Rate for Payer: Hawaii Western Management Group Commercial	$120.35
Rate for Payer: Hawaii Western Management Group Commercial	$120.70
Rate for Payer: Health Management Network Commercial	$107.68
Rate for Payer: Health Management Network Commercial	$107.99
Rate for Payer: Kaiser Permanente Commercial	$79.81
Rate for Payer: Kaiser Permanente Commercial	$80.04
Rate for Payer: Kaiser Permanente Medicaid	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$64.61
Rate for Payer: MDX Hawaii PPO	$123.24
Rate for Payer: MDX Hawaii PPO	$122.88
Rate for Payer: UnitedHealthcare Medicaid	$76.01
Rate for Payer: UnitedHealthcare Medicaid	$76.23
Rate for Payer: University Health Alliance Commercial	$92.34
Rate for Payer: University Health Alliance Commercial	$92.61

NYSTATIN 100000 UNIT/G TOP CR

Facility

$126.68

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$107.68
Max. Negotiated Rate	$122.88
Rate for Payer: Cash Price	$82.34
Rate for Payer: Cash Price	$82.58
Rate for Payer: Health Management Network Commercial	$107.68
Rate for Payer: Health Management Network Commercial	$107.99
Rate for Payer: MDX Hawaii PPO	$122.88
Rate for Payer: MDX Hawaii PPO	$123.24

NYSTATIN 100000 UNIT/G TOP POWD

Facility

$131.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$111.95
Max. Negotiated Rate	$127.76
Rate for Payer: Cash Price	$85.61
Rate for Payer: Cash Price	$116.17
Rate for Payer: Cash Price	$280.13
Rate for Payer: Cash Price	$63.90
Rate for Payer: Health Management Network Commercial	$151.91
Rate for Payer: Health Management Network Commercial	$366.32
Rate for Payer: Health Management Network Commercial	$83.56
Rate for Payer: Health Management Network Commercial	$111.95
Rate for Payer: MDX Hawaii PPO	$127.76
Rate for Payer: MDX Hawaii PPO	$173.36
Rate for Payer: MDX Hawaii PPO	$95.35
Rate for Payer: MDX Hawaii PPO	$418.04

NYSTATIN 100000 UNIT/G TOP POWD

Facility

$430.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$219.79
Max. Negotiated Rate	$418.04
Rate for Payer: Cash Price	$280.13
Rate for Payer: Cash Price	$116.17
Rate for Payer: Cash Price	$85.61
Rate for Payer: Cash Price	$63.90
Rate for Payer: Hawaii Western Management Group Commercial	$409.42
Rate for Payer: Hawaii Western Management Group Commercial	$125.12
Rate for Payer: Hawaii Western Management Group Commercial	$169.78
Rate for Payer: Hawaii Western Management Group Commercial	$93.39
Rate for Payer: Health Management Network Commercial	$366.32
Rate for Payer: Health Management Network Commercial	$83.56
Rate for Payer: Health Management Network Commercial	$111.95
Rate for Payer: Health Management Network Commercial	$151.91
Rate for Payer: Kaiser Permanente Commercial	$271.51
Rate for Payer: Kaiser Permanente Commercial	$112.59
Rate for Payer: Kaiser Permanente Commercial	$61.93
Rate for Payer: Kaiser Permanente Commercial	$82.98
Rate for Payer: Kaiser Permanente Medicaid	$67.17
Rate for Payer: Kaiser Permanente Medicaid	$219.79
Rate for Payer: Kaiser Permanente Medicaid	$91.15
Rate for Payer: Kaiser Permanente Medicaid	$50.13
Rate for Payer: MDX Hawaii PPO	$127.76
Rate for Payer: MDX Hawaii PPO	$173.36
Rate for Payer: MDX Hawaii PPO	$418.04
Rate for Payer: MDX Hawaii PPO	$95.35
Rate for Payer: UnitedHealthcare Medicaid	$258.58
Rate for Payer: UnitedHealthcare Medicaid	$107.23
Rate for Payer: UnitedHealthcare Medicaid	$58.98
Rate for Payer: UnitedHealthcare Medicaid	$79.03
Rate for Payer: University Health Alliance Commercial	$314.13
Rate for Payer: University Health Alliance Commercial	$71.65
Rate for Payer: University Health Alliance Commercial	$130.27
Rate for Payer: University Health Alliance Commercial	$96.00

Know your out-of-pocket cost for care.

All Charges